UC-NRLF 


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CEREBRAL  LOCALIZATION 


IN  RELATION  TO 


INSANITY. 


UNIVERSITY  OF  CALIFORNIA 

SAN  FRANCISCO  MEDICAL  CENTER 

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CEREBRAL    LOCALIZATION 


IN  KELATION    TO 


INSANITY, 


WITH  CASES. 


[Read  before  the  Medico-Legal  Society,  May  14,  1884.] 


J.    M.    CARNOCHAN,    M.D., 

Subgeon-in-Cheef   to    the  State  Immigrants'  Hospital,  1850  to  1873,  1880   to   1883— 

Pbofebsob    of    Sttrgeby — ^Foemeelt    Health    Officeb    op    the    Pobt 

OF    New   Yobk  and   one  of    the   Commissionebs   of   the 

Health    Depaetment    of   the  City   of   New 

Yobk— Membee  of  The  Medico-Legal 

Society   of  New    Yobk, 

Etc.,     Etc. 


RE-PRINT  FROM  MEDICO-LEGAL    JOURNAL. 
NEW  YOBK  : 

J.  H.  VAIL  &  CO. 

18  8  4. 


253604 


New  York  : 

Vanden  Houten  &  Co.,  Printers, 

47  &  49  Liberty  St. 


"rffr I 


1 1 


PEEFATORY  NOTE. 

With  the  great  and  rapid  increasing  immigration  into  the  United  States 
from  184.0  to  1847,  it  became  necessary  to  take  some  action  in  order  to  pro- 
vide for  the  care  and  relief  of  immigrants  who  might  most  require  aid  and 
protection,  and  to  adopt  some  measures  from  motives  of  State  economy.  The 
number  of  immigrants  suffering  from  disease  and  accidej^t  increased 
beyond  the  proportion  of  the  increase  of  immigration.  To  remedy  the 
evils,  urgent  at  the  time,  the  Legislature  of  the  State  of  New  York  ap- 
pointed a  Permanent  Commission  for  the  Relief  and  Protection  of  Aliens 
arriving  at  the  Port  of  New  York,  the  expense  to  be  defrayed  by  a  small 
commutation  payment,  from  each  immigrant.  Under  the  auspices  of  this 
Commission,  the  Honorable  Julian  C.  Verplanck  acting  as  President,  the 
foundation  of  the  large  Hospital  and  Refuge  establishment  was  laid  for  the 
benefit  of  the  immigrant,  on  a  healthy  island  contiguous  to  110th  street,  in 
the  12th  Ward  of  the  city.  Soon  after  the  construction  of  these  Institu- 
tions, without  change  of  residence,  I  was  placed  at  the  head  of  the  Surgi- 
cal Department,  with  continuous  service,  and  a  sufficient  number  of  com- 
petent assistants.  The  Hospital  consisted  of  Departments  embracing 
General  and  Special  Surgery,  Medicine  and  Obstetrics.  To  these  was  added 
a  Department  for  Lunatics,  on  account  of  the  increase  of  insanity  among 
the  immigrant  population,  scattered  through  differents  parts  of  the 
country. 

Acting  in  concert  with  the  Resident  Physician-in-Chief,  the  late  Dr. 
George  Ford,  there  being  no  special  Alienist  attached  to  the  Institution,  I 
had  ample  means  afforded  for  observing  and  studying  the  characteristics 
and  abnormal  conditions  of  the  insane.  From  the  opportunities  thus  pre- 
sented, and  from  observations  derived  from  cases  necessarily  occurring  in 
the  current  of  private  practice,  I  became  satisfied  that  insanity  is  a  morbid 
condition  of  the  mind,  resulting  directly  or  indirectly  from  disease  of  a 
part  or  of  the  whole  of  the  Brain,  or  from  imperfect  development,  and  that 
it  is  not  a  disease  of  the  mind,  per  se,  independent  of  functional  or  struc- 
tural change. 

This  view  of  the  pathological  source  of  Insanity  bears  directly  upon  the 
Medico-Legal  aspect  of  the  subject,  and  at  the  suggestion  of  the  Society,  I 
have,  amidst  a  press  of  professional  business,  drawn  up  the  following 
paper. 

14  East  16th  Steeet, 
June,  1884. 


"What  should  fairly  and  honestly  be  weighed  is,  that  mental  organiza- 
-tion  is  the  last,  the  highest,  the  consummate  evolution  of  nature,  and  that, 
therefore,  it  must  be  the  last,  the  most  complex,  and  most  difficult  object 
of  human  study." — Physiology  of  Mind. — Maudslby. 


CEREBRAL  LOCALIZATION   IN  RELATION 
TO  INSANITY.* 

By  J.  M.  CAENOCHAN,  M.D.,  &c. 


The  Localization  of  Cerebral  disease  has,  of  late  years,  en- 
gaged a  large  share  of  the  attention  and  labors  of  medical 
scientists.  Germany,  France  and  England,  during  the  last  de- 
cade, have  gained  celebrity  by  the  physiological  and  patho- 
logical investigations  and  the  knowledge  contributed,  by  some 
of  their  distinguished  men,  in  this  department  of  neuro- 
pathic research.  The  term  Cerebral  Localization  is  derived 
from  the  fact  now  generally  accepted  that  the  brain,  or  the 
large  nervous  mass  occupying  the  cranial  cavity,  is  not  a 
single  organ  performing  a  single  function,  but  that  it  is  com- 
posed of  an  aggregation  of  many  organs  or  cerebral  centres, 
each  possessing  special  functions,  acting  separately  at  times, 
but  at  others,  functionating  in  concert  by  a  pre-established 
harmony  of  action,  by  means  of  which  the  numerous  com- 
plex pTienomena  of  mental  manifestations  are  produced. 

A  knowledge  of  the  principles  and  facts  underlying  the 
doctrine  of  cerebral  localization  has  become  a  necessary  in- 
troduction to  the  study  and  comprehension  of  insanity. 

The  subject  of  insanity  is  one  of  great  interest  in  a  medico- 
legal point  of  view,  not  only  on  account  of  the  frequency 
with  which  this  condition  is  brought  before  the  courts  of 


*  Read  before  the  Medico-Legal  Society,  of  New  York,  May  14,  1884. 


6     '  CEREBKAL  LOCALIZATION 

law  for  adjudication  in  reference  to  tlie  possession  and 
management  of  property,  but  also  in  cases  of  criminal  juris- 
prudence where  grades  of  punishment  are  being  balanced  in 
the  scale  of  justice,  and  the  life  of  the  individual  is  often- 
times at  stake.  There  is,  also,  the  philosophical  and  physio- 
logical view  of  the  subject  in  regard  to  its  nature,  etiology 
and  the  various  phases  which  it  assumes,  and  this  may  be 
called  the  medical  aspect.  The  fact  that  opinions  regarding  the 
nature  of  insanity  differ  so  widely,  implies  that  the  study  of 
its  characteristics  is  one  of  difficulty.  In  this  respect  in- 
sanity resembles  some  other  morbid  conditions  of  the  organ- 
ism, such  as  catalepsy,  epilepsy,  hydrophobia  and  other 
abnormal  states  of  the  nervous  system  that,  as  yet,  are  not 
clearly  comprehended.  The  localization  of  the  different 
functions  of  the  brain,  with  the  view  of  removing  the  obscur- 
ity connected  with  the  etiology  and  pathology  of  cerebral 
diseases  in  general,  has  within  the  past  few  years  received 
more  attention  and  careful  study  than  at  any  previous  time, 
and  a  new  and  more  enlarged  field  has  been  opened  up  in 
this  department  of  scientific  knowledge.  Emanating  from 
these  researches,  more  exact  opinions  regarding  the  nature 
of  insanity  are  being  entertained  that  are  likely  to  remove 
the  confusion  and  complexity  which,  heretofore,  have  been 
prevalent  in  discussions  and  opinions  concerning  the  various 
phases  of  mental  aberration. 

It  is  customary  in  the  ordinary  curriculum  of  medical  stu- 
dies to  give  attention  to  the  healthy  structure  of  the  human 
body,  in  order  to  acquire  the  knowledge  necessary  to  under- 
stand its  diseases  or  morbid  conditions.  So,  in  the  study 
of  diseases  of  the  brain,  of  which  insanity  is  one,  it  becomes 
necessary  to  be  conversant  with  the  minute  structure  and 


IN  RELATION    TO  INSANITY.  •      7 

physiology  of  the  brain  and  the  other  parts  of  the  nervous 
system,  I  shall  endeavor  to  follow  this  rule  and  take  a  hurried 
glance  at  the  different  views  entertained  regarding  the  healthy 
action  of  the  mind  before  reaching  the  main  subject  of  this 
paper — that  of  insanity. 

In  looking  into  the  history  of  mental  philosophy  and  re- 
tracing it  for  centuries  back,  even  to  the  epoch  when  phi- 
losophy, such  as  it  was  when  it  first  assumed  a  name,  it 
becomes  a  matter  of  surprise  to  the  student  of  the  present 
day  to  observe  how  indefinite  and  vague  were  the  notions  en- 
tertained by  the  ancient  philosophers  concerning  the  nature 
and  action  of  the  healthy  mind — the  mens  sana.  With  such 
erroneous  and  intangible  theories  and  vague  and  unintelli- 
gible hypotheses  as  are  found  in  their  writings,  it  might  be 
asked  how  could  it  be  possible  to  arrive  at  correct  opinions 
and  conclusions  when  discussing,  or  writing  on  the  com- 
plexities of  the  diseased  mind — or  insanity,  the  mens  non 
compos. 

The  history  of  the  early  centuries  of  the  world  affords 
only  indefinite  information  regarding  the  study  of  mental 
phenomena.  Some  individuals  were  considered  more  wise 
than  others,  and  were  often  supposed  to  be  endowed  with 
supernatural  gifts.  Possessing  acute  and  enlarged  powers 
of  observation,  and  from  a  close  study  of  human  character, 
they  gained  control  over  their  compeers,  became  chiefs,  great 
warriors,  teachers,  or  astute  law-makers  for  their  time,  and 
formed  systems  and  rules  of  conduct  for  the  guidance  of  their 
own  actions  and  those  of  their  followers.  Solon  and  Thales  and 
the  remaining  ^ye  of  the  seven  wise  men,  mentioned  as  living 
before  the  ante-Christian  era,  494  B.C.,  were  called  2o^iffTat 
(teachers  of  wisdom),  to  denote  their  practical  sagacity  rather 


8  CEREBRAL    LOCALIZATION^ 

than  their  knowledge  of  philosophy  as  such,  Heroclitus  is 
considered  as  the  oldest  writer  (445  B.C.)  known  to  have  in- 
troduced the  term  philosophy,  as  denoting  a  system  the 
object  of  which  was  the  acquisition  of  true  knowledge,  and 
which  would  reach  facts  in  the  concatenation  of  cause  and 
effect.  Prior  to  the  time  of  Heroditus,  however,  the  scholars 
of  the  day,  groping  amidst  the  complexities  of  mental  specu- 
lations, felt  the  necessity  of  drawing  distinctions  between 
the  different  functions  and  manifestations  of  the  mind,  and 
hence  originated  the  numerous  sects  that  received  denomi- 
nations according  to  the  name  of  their  authors,  or  to  the 
hypotheses  identified  with  the  peculiar  doctrines  promul- 
gated. Among  this  class  of  reasoners  may  be  enumerated 
the  Electics,  the  Dialectics,  the  Ionics,  the  Atomists,  the 
followers  of  Pythagoras,  of  Plato,  of  Socrates  and  of 
Aristotle. 

The  founders  of  these  and  other  ancient  schools  of  phil- 
osophy became  famous  by  the  promulgation  of  theories  of 
mental  action  mixed  up  with  speculation  concerning  ethics, 
religion,  the  pursuit  of  happiness,  justice,  moral  culture, 
cosmology,  metempsycosis  etc.  The  Ionic  school  may  serve 
as  a  type  of  the  methods  and  train  of  thought  that  agitated 
the  minds  of  the  ante-Christian  philosophers.  One  of  the 
problems  of  the  Ionics  was  the  attempt  to  generalize  the 
universe,  and  to  resolve  all  nature  into  some  great  unity  or 
common  substance  or  principle.  Thales  considered  water 
the  primordial  and  fundamental  principle.  Anaximander 
adopted  as  the  foundation  of  the  universe  something  called 
by  him  the  Infinite  or  Indeterminate,  out  of  which  the  various 
definite  substances,  air,  fire,  water  etc.,  were  generated,  and 
to  which  they  were  again  resolved.    Anaximenes  assumed 


In  relation  to  insanity.  9 

air  as  the  primordial  substance  which  by  rarifaction  pro- 
duced fire  and  ether,  and,  by  condensation,  water,  air  and 
stone.  Pythagoras  gave  the  harmony  of  numbers  as  the 
essence  and  foundation  of  all  existing  things,  the  different 
numbers  being  representative  of  different  natural  properties 
and  powers.  The  Atomic  theory  was  represented  by  De- 
mocritus  430  B.C.,  who  attempted  the  solution  of  the  grand 
problem  of  external  perception,  regarded  as  a  leading  ques- 
tion, by  the  application  of  the  Atomic  hypothesis.  He 
supposed  that  all  things  were  constantly  throwing  off  images 
of  themselves,  which  enter  the  soul  through  the  pores  of 
the  organs  of  sense. 

Socrates,  435  B.C  ,  repudiated,  the  speculative  doctrines  of 
the  philosophers  who  had  gone  before  him  as  to  the  origin 
of  all  things  out  of  water,  fire,  air,  etc.,  and  led  the  way  to  a 
more  precise  method  of  thought  by  considering  evidence  as 
the  basis  of  reasoning,  and  teaching  that  all  human  things 
should  be  learned  by  diligence  in  study  and  investigation. 
The  Platonic  philosophy  differed  from  the  Socratic,  in  as 
much  as  the  doctrines  of  Socrates  were  founded  on  the 
necessity  of  external  evidence  in  reasoning,  while  the 
platonic  school  is  based  upon  idealism,  as  opposed  to  realism, 
materialism,  or  sensationalism,  the  capacity  of  forming  and 
using  ideas  being  taken  as  an  essential  quality  of  the  mind 
as  contrasted  with  the  external  forms  by  which  these  forces 
are  manifested.  Aristotle,  384,  B.C.,  the  pupil  of  Plato, 
taught  a  philosophy  differing  from  that  of  Plato  in  many 
points,  especially  in  the  fundamental  doctrine  termed  the 
theory  of  ideas.  The  entire  method  of  Aristotle  was  in 
marked  contrast  to  the  platonic  system  of  viewing  philo- 
sophical subjects.     Aristotle  was  a  close  observer  and  col- 


10  CEREBRAL    LOCALIZATION 

lector  of  facts,  from  which  he  drew  inductions.  He  promoted 
the  development  of  syllogistic  reasoning,  and  introduced  a 
system  of  formal  logic  which  became  insensibly  infused  into 
the  minds  of  succeeding  scientists,  and  has  contributed 
much  to  form  what  is  correct  in  the  methods  of  modern 
metaphysicians. 

The  Epicurean  sect  and  that  of  the  Stoics  formed  in  part 
upon  the  Aristotelian  doctrines,  transmitted  their  philosophy 
and  characteristic  mental  speculations  from  the  Socratic 
epoch  into  the  commencement  of  the  Christian  era.  Thus 
for  over  three  thousand  years,  preceding  the  time  that  philo- 
sophical theories  taught  by  Confucius  and  his  contempor- 
aries in  the  East  became  known  in  the  "West,  the  history  of 
philosophy  informs  us  that  the  different  doctrines  and 
mental  speculations  were  mainly  made  up  of  controversial 
theories  and  hypotheses  concerning  the  operations  of  the 
mind  based  upon  no  more  solid  foundation  than  the  meta- 
physical vagaries  and  propositions  of  the  acknowledged 
leaders  and  champions  of  the  popular  and  prevailing  sects 
of  the  period  in  which  they  flourished.  In  the  early  cen- 
turies, after  the  introduction  of  Christianity  and  the  Eoman 
Conquest,  Alexandria,  from  its  geographical  position,  be- 
came the  focus  at  which  the  philosophers  of  the  East  and 
West  congregated  and  interchanged  their  various  dogmas 
and  theories  regarding  theology,  literature,  politics,  psycho- 
logy and  other  metaphysical  topics  of  the  day.  At  this  time 
the  school  of  Neo  Platonism^ounded  on  the  doctrines  of  Plato, 
took  its  origin  and  became  the  representative  centre  of  the 
speculative  notions  that  grew  up  in  the  Alexandrian  school, 
from  the  "  fusion  of  Greek  philosophy.  Oriental  mysticism 
and  the  Jewish  and  Christian  controversies  on  religion." 


IN  RELATION  TO   INSANITY.  11 

The  school  of  Gnosticism,  composed  of  men  of  knowledge, 
as  the  name  implies,  arose  in  the  Second  century.  Its 
speculations  on  the  mind  were  mainly  based  upon  the  doc- 
trines of  Plato,  and  one  of  its  principal  efforts  and  studies 
was  directed  towards  creating  a  philosophy  upon  a  Christian 
foundation.  Great  theologians  and  metaphysicians  belonged 
to  this  school.  The  Ecumenical  Councils,  famous  in  ecclesi- 
astical history,  held  at  Nice,  a  city  of  Bythnia,  in  Asia  Minor, 
in  325,  and  787,  were  made  up  of  scholars  of  this  class,  among 
whom  may  be  mentioned  Athanasius,  Gregory  of  Nysa  and 
St  Augustine,  who  were  noted  for  their  physiological  labors 
and  mental  disquisitions. 

In  the  ninth  century  the  Scliolastics  appeared,  and  early  in 
their  history  became  remarkable  for  their  controversies  on 
nominalism  and  realism^  and  later  by  the  revival  of  the  school 
of  Aristotle  and  the  refutation  of  the  doctrines  of  Pantheism. 
The  names  of  Alexander,  of  Bonaventura,  Albertus  Magnus, 
Duns  Scotus  and  Thomas  Aquinas,  were  conspicuous  at  that 
period,  among  the  great  theologians  and  teachers  of  this 
school.  From  this  time  forward,  during  the  following  centu- 
ries, until  the  time  of  Roger  Bacon,  1214-1294,  numerous 
teachers  and  schools  sprang  into  activity,  more  especially  in 
the  Western  region  of  civilization,  chiefly  occupied  with  theo- 
ries on  nominalism,  realism,  idealism,  immortality  of  the  soul 
and  other  subjects  appertaining  to  the  domain  of  meta- 
physical enquiry,  and  then  receded,  after  having  exercised, 
for  a  time,  their  period  of  authority.  The  Platonic  and 
Aristotelian  doctrines  which,  for  many  centuries,  had  formed 
the  basis  of  the  different  sects  of  philosophers,  had  prepared 
the  way  for  a  closer  system  of  ratiocination.  During  the 
16th  century  and  early  part  of  the  17th,   (1561-1626,)  a  new 


12  CEREBKAL    LOCALIZATION 

class  of  pliilosopliers  appeared  who  abandoned  the  tradi- 
tional servitude  of  authority  dictated  by  their  predeces- 
sors, and  adopted  new  methods  in  the  analyses  of  n.ental 
phenomena.  About  this  epoch  the  names  of  Francis  Bacon 
and  Rene  Descartes  became  conspicuous  in  the  philosophi- 
cal world— 1561-1596. 

Between  the  sixteenth  and  eighteenth  centuries  (that  is 
between  the  time  that  Francis  Bacon  enlightened  the  philo- 
sophical world  by  his  writings  and  John  Wilson,  the  famous 
Christopher  North,  who  occupied  the  chair  of  mental  and 
moral  philosophy  in  the  University  of  Edinburgh,  1830),  many 
remarkable  men  lived  and  left  the  imprint  of  their  powerful 
minds  on  the  age  in  which  they  figured,  by  their  philosophical 
essays  and  more  elaborate  works.  Francis  Bacon,  Descartes, 
■Thomas  Hobbes,  Locke,  Malabranche,  D'Alembert,  Leibnitz, 
Bishop  Berkeley,  Hume,  Kant,  Condillac,  Condor^et,  Thomas 
Reid,  Dugald  Stewart,  Thomas  Brown,  John  Wilson  and  Sir 
William  Hamilton  may  be  named  as  among  the  most  bril- 
liant of  the  minds  that  shed  lustre  on  the  civilized  world, 
during  this  epoch.  Each  of  these  philosophers  discussed 
with  earnestness  and  ability  subjects  embracing  the  general 
domain  of  mental  philosophy,  morals,  theology,  politics,  the 
various  processes  of  mental  action  and  physics,  each  adopt- 
ing peculiar  methods  of  ratiocination  and  of  mental  analyses, 
and  often  guided  by  antecedent  education  and  early  sur- 
roundings. 

Bacon  is  generally  accredited  with  leading  the  way  to 
more  correct  methods  of  analytic  enquiry  by  the  intro- 
duction of  the  inductive  method.  This  system  undoubtedly 
formed  the  basis  of  a  more  accurate  and  precise  school  of 
reasoning,  for,  in  regard  to  whatever  supposition  or  theory 


IN   RELATION  TO   INSANITY.  13 

of  mental  action  miglit  be  started  and  advocated,  the  in- 
ductive method  was  generally  adopted,  in  order  to  prove  and 
substantiate  its  correctness. 

Descartes,  as  one  of  the  early  reformers,  professed  to 
admit  nothing  as  true  that  was  not  confirmed  by  reason  and 
experiment.  He  found,  as  he  supposed,  no  ground  for  certi- 
tude in  any  of  the  various  departments  of  knowledge  except 
one,  and  only  one  proposition  that  seemed  to  him  to  stand 
the  test  of  truth,  and  of  which  the  truth  could  not  be 
doubted.  That  proposition  was  that  he  existed,  which  he 
inferred  from  the  fact  of  his  possessing  consciousness.  He 
could  not  doubt  that  he  felt  and  thought,  and,  therefore,  he 
did  not  doubt  that  he,  the  feeler  and  thinker,  existed.  This 
relation  between  consciousness  and  existence  he  expressed 
by  the  words  "  Cogito,  ergo  sum " — "  I  think,  therefore,  I 
exist."     Such  was  one  of  the  dogmas  of  Descartes. 

The  philosophical  system  of  Hobbes,  who  was  contempo- 
raneous with  Bacon  and  Descartes,  was  of  the  materialistic 
type.  He  held  sensation  to  be  the  basis  of  all  knowledge, 
thought  to  be  a  process  of  adding  and  subtracting  repre- 
sentations produced  by  physical  impressions,  and  intro- 
duced a  twofold  method  of  scientific  investigation  by  in- 
diiction  or  analysis  and  deduction  or  synthesis. 

The  essay  on  the  "  Human  Understanding,"  by  Locke,  ap- 
peared in  1690,  and  was  regarded  as  the  great  authority  by 
the  sensualistic  philosophers  of  the  eighteenth  century.  His 
system  tries  to  show  that  there  are  no  "  innate  ideas,''  that 
the  mind  is  a  tabula  rasa,  ideas  being  used  for  whatever  is  in 
the  mind.  His  main  postulates  are  laid  down  by  himself  as 
follows  : — "  Let  us  suppose  the  mind  to  be,  as  we  say,  white 
paper,  void  of  all  characters,  without  any  ideas,  how  comes 


14  CEREBRAL    LOCALIZATION 

it  to  be  furnished  ?  Whence  has  it  all  the  materials  of 
reason  and  knowledge?  To  this  I  answer  in  one  word, 
from  experience.  In  that,  all  knowledge  is  founded,  and  from 
that  it  ultimately  derives  itself."  *  *  *  *  And,  again, 
"Our  observation  employed  either  about  external  sensible 
objects,  or  about  the  internal  operations  of  our  own  minds, 
perceived  and  reflected  un  by  ourselves,  is  that  which  sup- 
plies our  understanding  with  all  the  materials  of  thinking. 
These  two  are  the  fountains  of  knowledge  from  whence  all 
the  ideas  we  have,  or  can  naturally  have,  do  spring.  These 
are  called  stiisaiion  and  7'e/lection,  and  it  is  important  to 
observe  thafc  the  latter  must  wait  on  the  former." 

Such,  in  brief,  may  be  said  to  comprise  the  principal 
dogmas  of  one  of  the  greatest  philosophers  of  the  last 
century. 

It  is  somewhat  remarkable  that  the  postulates  of  Locke 
somewhat  coincide  with  the  theories  of  Gall,  who  based  his 
doctrines  upon  the  localization  of  certain  faculties  in  special 
parts  of  the  brain,  while  Locke  reached  his  conclusions 
through  introspective  and  abstract  ratiocination.  Bishop 
Berkeley  followed  soon  after  Locke,  and  published  among 
other  writings  his  "  Treatise  Concerning  the  Principles  of 
Human  Knowledge,"  in  which  he  proposed  a  scheme  of  ab- 
solute Idealism.  He  affirmed  that  there  was  no  proof  of  the 
existence  of  a  material  world,  and  gave  the  name  of  "  ideas  '* 
to  the  objects  of  which  we  are  conscious  in  perception,  attri- 
buting them  to  a  supernatural  agency  that  causes  them  to 
pass  in  a  real  and  orderly  succession  before  the  mind. 

In  contrast  with  the  school  of  Berkeley,  Hume's  philoso- 
phy was  directed  towards  naturalism  and  scepticism.  He 
believed  that  ideas  were  copies  of  impressions  of  individual 


IN  EELATION    TO    INSANITY.  15 

things.  He  gives  an  exposition  of  the  basis  of  his  system 
thus  : — '*  All  the  perceptions  of  the  human  mind  resolve 
themselves  into  two  distinct  kinds,  which  I  call  impressions 
and  ideas.  The  difference  between  them  consists  in  the 
degrees  of  force  and  liveliness  with  which  they  strike  upon 
the  mind  and  make  their  way  into  our  thought  and  con- 
sciousness. Those  perceptions  which  enter  with  most  force 
and  violence  we  may  name  impressions,  and  under  this  name 
include  all  our  sensations,  passions  and  emotions  as  they 
make  their  first  appearance  in  the  soul.  By  ideas  I  mean 
the  faint  images  of  these  in  thinking  and  reasoning."  The 
opinions  of  Hume  had  great  currency,  and  became  the  stimu- 
lating influence  of  the  notable  systems  of  D'Alembert,  Mar- 
montel,  Diderot,  Condor^et,  Condillac,  Helvetius,  Males- 
herbes  and  other  philosophers  of  his  time. 

Kant,  1724,  became  imbued  with  the  scepticism  of  Hume 
in  regard  to  the  objective  validity  of  our  ideas,  especially  in 
relation  to  the  idea  of  causality.  He  conceived  a  system  of 
critical  philosophy  which,  from  its  metaphysical  character, 
had  received  the  name  of  transcendentalism.  The  central 
object  of  this  system  seems  to  be  twofold  ;  first,  to  separate 
the  necessary  and  universal  incogaition  from  the  knowledge 
we  derive  through  the  senses ;  secondly,  to  determine  the 
limits  of  cognition.  It  is  difficult  to  follow  the  transcenden- 
tal ratiocination  of  Kant,  and  probably  the  nearest  concep- 
tion we  can  obtain  of  his  meaning,  except  by  a  deep  study 
of  his  various  works,  is  derived  from  the  definition  given  of 
the  word  transcendental,  which  has  been  applied  to  his 
system — viz,  '*  all  philosophy  which  carries  its  investigations 
beyond  the  sphere  of  things  which  fall  under  our  senses  is 
transcendental,  and  the  term  is  thus  synonymous  with  meta- 


16  CEREBRAL    LOCALIZATIOI^ 

physical.  Transcendental  philosophy  may  begin  with  ex- 
perience, and  thence  proceed  beyond  it ;  or  it  may  start 
from  ideas  a  priori  which  are  in  our  mind.  In  the  latter 
case,  the  philosophy  is  purely  transcendental,  while  in  the 
former  it  is  of  a  mixed  character." 

Leibnitz,  1646-1716,  remarkable  for  his  scholarship  and 
the  vastness  of  its  range,  is  perhaps  more  noted  for  his  doc- 
trines of  the  action  of  the  mind  than  for  his  other  great  ac- 
quirements. The  most  important  hypotheses  of  his  system 
may  be  stated  to  be  his  doctrine  as  to  the  origin  of  Ideas,  his 
theory  of  the  Monads,  of  the  pre-established  Harmony  and 
the  theory  of  Optimism.  Ideas  are  supposed  to  come  from 
spiritual  Monads ;  the  theory  of  Optimism  affirms  the  doc- 
trine that  the  universe,  being  the  work  of  an  infinitely  per- 
fect Being,  is  the  best  that  could  be  created  ;  that  everything 
is  ordered  eventually  for  the  best,  so  that  everything  is  good 
in  relation  to  the  whole — all  being  made  to  promote  the 
general  good. 

His  celebrated  doctrine  of  pre-established  Harmony  is 
that  which  has  claimed  most  attention.  It  supposes  "  the 
mind  and  the  body  to  be  two  distinct  and  independent  ma- 
chines, each  having  its  own  independent  though  simultane- 
ous action,  but  both  so  regulated  by  a  harmony  pre-established 
by  God,  that  their  mutual  actions  shall  correspond  with  each 
other,  and  shall  occur  in  exact  and  infallible  unison."  This 
hypothesis  has  been  called  by  another  philosopher  "  the 
dream  of  a  great  mind." 

Thomas  Keid,  one  of  the  noted  Scotch  philosophers,  pub- 
lished several  essays  on  philosophical  subjects  :  in  1785,  his 
treatise  on  the  Philosophy  of  the  Intellectual  Powers  ;  and 
in  1788,  the  philosophy  of  the  Active  Powers  appeared.    His 


tN  RELATION    TO  INSANITY.  Vt 

Writings  attracted  much  attention,  and  he  became,  in  his  own 
country,  the  chief  of  a  school  whose  aim  was  to  "  deliver 
philosophy  from  scepticism  by  resting  finally  on  principles 
of  intuitive  or  a  priori  origin."  Eeid  was  succeeded  in  Scot- 
land by  Dugald  Stewart  (1775) ;  and  Thomas  Brown  (1809),  fol- 
lowed up  the  controversies  begun  by  Reid  against  the  systems 
of  Berkeley  and  Hume.  Brown  was  succeeded  by  John  Wil- 
son as  professor  of  moral  and  mental  philosophy  in  the 
University  of  Edinburgh,  and  he  was  succeeded  by  Sir 
William  Hamilton.  The  two  last  named  teachers  were  pro- 
found scholars,  and  contributed  learned  essays  and  treatises 
on  subjects  connected  with  the  study  of  the  mind,  ethics  and 
politics,  but  their  names  are  not  associated  with  any  import- 
ant system  in  the  domain  of  mental  philosophy. 

It  is  seen  from  the  brief  apergu  just  made,  that  the  various 
philosophical  systems  heretofore  mentioned  as  controlling 
the  psychological  world,  since  the  commencement  of  the 
Christian  era,  have  been  constructed  by  the  introspective 
action  of  the  mind  itself,  acting  upon  the  very  subject  which 
it  wishes  to  define  and  analyze,  without  any  premises  to  be 
used  as  the  basis  of  ratiocination  other  than  the  fleeting 
phases  of  the  mind  itself.  From  the  resulting  confusion  and 
the  variety  of  conjectural  speculations  that  have  arisen,  during 
so  many  centuries,  the  conclusion  to  be  most  readily  drawn 
is,  that  there  may  be,  as  D'Alembert  truly  says,  "  a  great 
deal  of  pJiilosophizing  in  which  there  is  very  little  of  philo- 
sophy." 

Since  the  time  of  Sir  William  Hamilton,  1829-36,  a  school 
of  philosophy  has  sprung  up  whose  methods  of  research  in 
the  realms  of  thought  are  based  on  the  materialistic  theory 
that  mental  manifestations,  of  whatever  character,  are  the 


18  CEREBRAL    LOCALIZATION 

essential  functions  of  vital  organizations.  Of  this  new  class 
of  scientists  Herbert  Spencer  may  be  mentioned  as  the  most 
distinguished  representative,  but  long  before  the  publica- 
tions of  this  writer  were  issued,  a  philosopher  had  appeared 
who  was  intently  engaged  in  the  prosecution  of  the  study  of 
the  Brain  and  nervous  system,  with  the  main  object  in  view 
of  confirming  his  theory  that  the  phenomena  of  mental 
manifestations  were  in  direct  correlation  with  the  structure 
and  development  of  the  cerebro-spinal  axis  and  the  nervous 
appendages  connected  with  it. 

Franz  Joseph  Gall  was  born  in  Baden  in  1753,  and  after 
studying  at  Baden,  Bruchsal  and  Strasbourg,  received  the 
degree  of  Doctor  of  Medicine  at  Vienna,  in  1785.  He  was 
possessed  of  unusual  powers  of  observation,  and  early  in  life 
began  to  observe  and  compare  the  craniological  formation 
of  man,  and  to  refer  the  variety  of  mental  peculiarities  and 
of  moral  characteristics  of  persons  thus  examined  to  the 
diversified  development  of  the  cranium,  resting  his  theory 
upon  the  alleged  approximate  similaritj^  existing  between 
the  outline  of  the  cranium  and  the  external  configuration  of 
the  Brain. 

In  1796,  he  gave  lectures  on  this  subject  in  Vienna,  but  the 
new  theory  met  with  much  opposition,  and  in  1805  he  was 
interdicted  by  the  government  from  repeating  his  lectures  in 
public.  Gall,  after  this,  visited  Paris,  and  entered  upon  the 
practice  of  medicine,  and  at  the  same  time,  with  his  pupil 
Spurzheim,  commenced  a  series  of  studies  upon  the  Brain 
and  nervous  system  that  resulted  in  the  completion  of 
several  important  works,  among  which  may  be  mentioned 
Philosophisch-Medlcinisclie  UntersucJiungen   (1791),    BecJierches 


IN  RELATION  TO   INSANITY.  19 

swr   le   Systeme   Nerveux   (1810-19),   and   Siir   VOrigine  des 
Qualites  Morales  et  de  Facultes  Intelleduelles  (1822-25). 

Spurzheira,  following  up  the  principles  of  his  master, 
visited  Scotland,  England,  and  finally  America,  giving  lec- 
tures to  inculcate  the  system  of  mental  philosophy  inaugu- 
rated by  Gall.  These  two  scientists,  like  most  founders  of  a 
sect,  claimed  too  much  for  their  theory.  Gall,  as  a  part  of 
his  system,  wished  to  establish  certain  empirical  doctrines 
under  the  term  of  phrenology,  upon  the  assumption  that  the 
relative  development  of  the  centres  of  the  brain  can  be  ac- 
curately determined  by  external  examination  of  the  cranium, 
"  by  protuberance  in  one  part  as  contrasted  with  depression 
in  another  quarter,  and  by  other  indications  in  their  nature, 
not  demonstrable,  in  any  special  instance,  without  post- 
mortem examination,  and  yet  having  a  certain  degree  of 
foundation  in  the  general  truths  of  physiology."  It  was  this 
pretention  of  imposing  an  untenable  dogma  upon  his  general 
system  that  led  to  the  rejection  of  his  general  theory  re- 
garding the  functionating  powers  of  the  brain.  The  leading 
positions  of  Gall,  however,  have  been  verified,  and  have 
been  absorbed  into  the  scientific  psychology  of  the  present 
epoch  under  the  denomination  of  psycho-physics  in  Ger- 
many and  cerebral  psychology  in  England.  Wagner, 
Huschke,  Bain,  Carpenter,  Terrier,  Spencer,  Huxley,  Tyndal, 
Maudsley  and  Darwin  are  the  leading  representatives  of  this 
school  of  philosophy  of  the  present  day. 

Still  the  subject  of  Insanity  is  clouded  by  the  dogmas  of 
the  metaphysical  school  of  philosophy,  and  is  so  entangled 
by  ancient  theories  concerning  the  normal  constitution  of 
the  mind  and  the  primeval  methods  of  studying  the  mind  in 


20  CEREBEAL    LOCALIZATION 

health  or  in  disease,  tliat  no  two  authors  can  be  found  who 
give  a  precisely  similar  definition  of  Insanit3^ 

Gall  commenced  his  system  of  localizing  the  organs  and 
functions  of  the  brain  by  apportioning  the  brain  into  regions, 
limiting  them,  in  general,  by  the  dividing  furrows  or  fissures 
of  the  several  lobes.  To  the  convolutions  of  the  frontal  lobe, 
the  intellectual  and  perceptive  group  of  centres  were  allotted. 
In  the  posterior  lobe  and  lower  range  of  the  middle  lobe,  the 
affective  organs  and  those  of  the  animal  propensities  were 
found ;  while  the  moral  and  aesthetic  group  of  centres  were 
located  in  the  upper  and  coronal  parts  of  the  brain.  The 
cerebellum  is  supposed  to  have  the  function  of  presiding 
over  procreative  activity.  As  concerns  these  propositions, 
with  the  exception  of  the  functions  attributed  to  the  cere- 
bellum, recent  experiments  in  vivisection  have,  in  a  great 
measure,  verified  their  accuracy.  No  one  conversant  with 
the  modern  discoveries  in  physiology  can  be  in  doubt,  even 
in  the  present  condition  of  medical  science,  concerning  the 
possibility  of  localizing  many  organs  of  the  brain  through 
the  activity  and  instrumentality  of  which  ct-rtain  spepial 
functions  are  made  manifest. 

The  discoveries  of  Sir  Charles  Bell,  1811,  corroborated  by 
Magendie  and  Longet  in  1840,  have  placed  the  spinal  centres 
of  general  sensibility  and  of  locomotion  in  the  posterior  and 
anterior  columns  of  the  medulla  spinalis,  and,  in  tracing  the 
nervous  strands  of  white  medullary  matter  and  the  gray 
cineritious  substance  of  this  organ  upwards  into  the  brain, 
at  different  sections,  the  motor  and  reflex  centres  of  the 
functions  of  respiration,  of  digestion,  of  the  tongue  and 
the  pharynx  are  definitely  located  at  the  medulla  oblon- 
gata.    Also,   in   connection   with   the   extended    continuity 


IN  RELATION  TO   INSANITY.  21 

and  prolongation  of  these  same  strands  and  ganglionic  depo- 
sits of  gray  matter  and  piercing  tlie  brain  at  the  junction  of  the 
medulla  oblongata  with  the  pors  varolii,  the  nerve  of  audition 
and  the  motor  nerve  of  the  face  are  seen,  the  first  taking 
origin  at  the  gray  matter  of  the  fourth  ventricle,  and  the 
second  connected  at  its  root,  with  the  motor  part  of  the 
medulla  oblongata.  Anterior  to  these,  and  still  in  connec- 
tion with  the  advancing  strands,  the  nerve  of  the  external 
rectus,  the  sixth  pair,  and  the  nerve  of  the  other  motor  muscles 
of  the  eye-ball  and  of  the  orbit,  the  third  pair,  are  met 
with — the  sixth  pair,  connected  with  the  medulla  oblongata, 
emanating  from  the  substance  of  the  brain  in  front  of  the 
pons  varolii ;  and  the  trunk  of  the  third  pair  from  the  side 
of  the  crus  cerebri,  from  the  deep  part  of  which  it  takes  its 
origin.  The  root  of  the  fourth  pair  of  nerves,  called  pathe- 
tici,  from  their  action  in  turning  the  globe  of  the  eye  upwards 
in  the  expression  of  prayer,  is  placed  near  the  surface  of  the 
fourth  ventricle,  at  the  calamus  scriptorius.  The  sensory 
portion  of  the  ffth  pair  of  nerves,  the  nerve  of  general  sensi- 
bility of  the  face  and  of  the  appendages  of  the  organs  of  spe- 
cial sense,  has  its  real  origin  localized  at  the  medulla 
oblongata  and  in  the  interior  of  the  pons  varolii,  and  is  seen 
piercing  the  po7is,  anteriorly  upon  its  external  side.  The 
motor  portion  of  the  fifth  pair  takes  its  origin  in  connection 
with  the  pyramidal  or  motor  portion  of  medulla  oblongata. 

The  nervous  centres  of  the  organs  of  special  sense,  of  smell, 
of  sight,  and  of  hearing,  can  also  be  localized  with  the  same 
degree  of  precision  and  certainty.  That  of  hearing,  the  por- 
tio  mollis  of  the  seventh  pair,  has  already  been  located.  The 
visual  centre  is  known  to  be  placed  in  connection  with  the 
tubercula  quadrigemina,  and  the  corpora  geniculata  of  the 


22  CEREBRAL    LOCALIZATION 

optic  thalamus  ;  and  that  of  the  olfacHve  sense  at  the  poste- 
rior part  of  the  anterior  lobe,  the  lower  part  of  the  middle 
lobe,  and  at  other  proximal  points  of  origin. 

The  great  basal  ganglia — the  tuhercula  quadrigemina^  the 
optic  thalami,  and  the  corpora  striata,  large  aggregations  of 
cineritious  nervous  substance,  intermingled  with  white  fibres 
seated  inferiorlj  and  in  the  interior  of  the  brain,  are  known 
to  be  auxiliary  to  the  functions  of  motion  and  of  general 
and  special  sensation,  and  to  serve  as  the  means  of  elaborat- 
ing the  nervous  influence  which  supplies  the  organs  that  are 
in  connection  with  them. 

The  evidences  and  examples  thus  given  of  the  identification 
of  certain  functional  manifestations,  such  as  motion  and  sen- 
sation, with  defined  or  limited  parts  of  the  medulla  spinalis 
'and  of  the  cerebral  strands  continued  from  it,  and,  also,  of  a 
similar  correlation  and  identification  between  the  functions 
of  the  special  senses  and  the  nervous  centres  on  which  they 
are  dependent,  serve  as  examples  of  the  reality  and  utility  of 
the  principle  of  localization,  and  are  as  much  mental  in 
character  as  those  functions  attributed  to  the  more  intro- 
spective or  psj'chological  organs. 

The  localization  of  the  functions  of  the  cerebral  convolu- 
tions on  the  surface  of  the  brain  has  not  been,  as  yet,  so 
absolutely  defined  or  limited  as  those  referred  to  in  the  in- 
terior and  lower  part  of  the  brain.  It  is  generally  conceded, 
however,  with  whatever  other  functions  they  may  be  classed, 
that  the  convolutions  placed  on  the  general  surface  of  the 
cerebrum  are  the  seat  of  the  intellectual  or  reasoning 
faculties  and  of  the  other  mental  functions  differently  mani- 
fested, such  as  the  emotions,  etc. 

Becently  a  new  role  has  been  assigned  to  the  cortex  of  the 


IN  RELATION    TO  INSANITY.  23 

cerebral  convolutions  to  which,  previously,  the  functionating 
power  of  the  superior  mental  qualifications  alone  had  been 
referred.  In  1870,  two  physiologists,  M  M.  Fritsch  and 
Hitzig,  remarked  that  an  electric  current  made  to  pass 
along  the  head  from  right  to  left  produced  movements  in 
certain  muscles  of  the  eyes.  Experiments  were  then  made 
upon  the  brains  of  dogs  and  other  inferior  animals,  with  re- 
sults of  a  similar  character.  In  1873,  Hitzig  published  a 
memoir  in  which  he  announced  that  the  electric  excitation 
of  certain  regions  on  the  surface  of  the  brain  produced  con- 
tractions in  certain  groups  of  muscles  connected  with  defi- 
nite movements  of  the  head,  body  and  limbs. 

About  the  same  time,  this  subject  was  pursued  farther  by 
Terrier  of  London,  who  made  his  experiments  upon  the 
brain  of  the  monkey,  as  being  more  closely  allied  in  con- 
figuration to  the  human  brain.  Ferrier  localized  the  motor 
regions  of  the  cerebral  hemispheres,  in  general  terms,  in  the 
convolutions  about  the  upper  portion  of  the  Fissure  of 
Kolando,  especially  in  the  ascending  frontal  and  ascend- 
ing parietal  convolutions.  Centres  of  sensation  have,  also, 
been  assigned  to  the  cortex  of  certain  parts  of  the  brain, 
but  these  have  not  been  localized  as  definitely  as  those  of 
motion,  but,  as  far  as  known,  are  supposed  to  be  localized  in 
the  postero-lateral  regions  of  the  hemispheres.  The  exper- 
iments and  statements  of  these  distinguished  physiologists 
have  given  an  extended  impetus  to  the  study  of  this  depart- 
ment of  physiology,  and  have  been  accepted  by  many 
as  established  facts.  On  the  other  hand,  active  opposition 
has  been  made  to  their  assertions,  the  motor  efi'ect  of  the 
electric  excitation  being  attributed  to  the  extension  of  its 
influence  to  the  medullary  fibres  passing  onward  from  the 


24  CEREBEAL    LOCALIZATIOI? 

corona  radiata  to  be  dovetailed  or  interlaced  among  the  several 
layers  of  the  cells  and  cineritious  substance  of  the  cerebral 
cortex.    This  argument  is  not  without  weight ;  for  example,  the 
optic  tracts  have  their  origin  in  three  separate  nuclei  of  gray 
matter,  viz.,  in  the  nates  of  the  tubercula  quadrigeminxx,  the 
corpus  geniculatum  externum   and   the   optic  thalamus,   and, 
according  to  Meynert  and  Huguenin,  there  are  indirect  con- 
nections between  these  nuclei  and  the  cortex  of  the  hemi- 
spheres, consisting  of  diverging  fibres  from  the  optic  thala- 
mus and  the  corpus  geniculatum.     These  fibres  take  part  in 
the  formation  of  the  corona  radiala,  and  pursue  their  course 
toward  the  gyrus  angularis  placed  at  the  posterior  part  of 
the  hemisphere  and  considered  by  Ferrier  as  a  visual  centre. 
Again,  in  disease  or  excitation  of  tlie  Convolution  of  Broca, 
the  same  general  explanation  may  be  given  in  regard  to  the 
voluntary  combination  of  ideation  and  of  muscular  movements 
necessary  for  intelligent  articulation,  the  motor  centre  of  which 
is  placed  in  correlation  with  the  posterior  and  lower  part  of 
the  third  left  frontal  convolution,  through  the  influence,  direct 
or  reflex,  of  the  fibres  of  the  hypoglossal  nerve  and  its  origin 
at  the  medulla  oblongata — the  defect  or  destruction  of  which 
combination  produces  aphasia  in  its  different  forms. 

There  are  two  kinds  of  aphasia,  the  amnesic  aphasia, 
where  the  patient  cannot  say  what  he  wishes,  because  he 
cannot  recollect  the  words  or  ideas  he  wants  to  express,  nor 
can  he  write  them  ;  and  the  ataxic  aphasia,  where  the  patient 
knows  the  words  or  ideas  he  wants,  but  cannot  speak  or 
read  aloud  or  articulate  even  what  he  has  written. 

These  conditions  are  entirely  distinct  in  origin  or  in 
causality — the  ideal  or  amnesic  aphasia  can  be  referred  to 
the  morbid  condition  of  the  cortex  alone,  and  the  ataxic 


tN  RELATION  TO  INSANITY.  2§ 

aphasia  to  the  abnormal  condition  of  the  hypoglossal  nerve 
and  the  white  substance  of  the  Broca  convolution.  If  both 
substances  of  the  convolution,  the  cortex  and  the  white  med- 
ullary substances,  are  diseased,  the  aphasia  becomes  com- 
plete, there  being  neither  the  ideation  of  language  nor  the 
power  of  articulating  it. 

There  is  probability  that  the  hypoglossal  or  motor  nerve 
of  the  tongue,  taking  origin  in  the  motor  apparatus  of  the 
bulb,  is  indirectly  in  connection  with  the  convolution  of  Broca 
through  radiating  fibres  communicating  with  the  bulb. 

The  theory  of  localizing  motor  and  sensory  centres  in 
the  cortex  of  the  hemispheres,  even  if  regarded  as  es- 
tablished, must  be  looked  upon  as  an  ancillary  arrangement. 
The  most  important  functions  belonging  to  the  cerebral 
hemispheres,  as  a  whole,  are  directly  connected  with  the 
exercise  of  the  various  psychical  or  mental  manifestations. 
This  correlation  of  the  mutual  dependence  of  function  upon 
organization  rests  upon  such  established  proofs  as  to  be  no 
longer  a  subject  of  argument  among  physiologists.  The  re- 
sults following  the  partial  or  total  removal  of  the  hemi- 
spheres by  vivisection  made  upon  the  lower  animals;  of  in- 
juries or  diseases  of  the  brain ;  and  of  imperfect  development, 
as  in  cases  of  idiocy,  can  only  be  alluded  to,  at  present,  as 
corroborative  of  the  physiological  fact  that  the  organs  of  the 
mind  are  located  in  the  encephalon,  and  are  mainly  func- 
tionalized  and  manifested  through  the  instrumentality  of  the 
hemispherical  ganglia  of  the  cortical  substance  of  the  cerebral 
convolutions. 

A  classification,  founded  upon  this  anatomical  basis  of  the 
normal  actions  of  the  mind,  is  likely  to  remain  and  take  pre- 
cedence of  other  classifications  resting  upon  purely  ideal 
hypotheses. 


26  CEREBKAL    LOCALIZATION 

If  the  regions  of  motor  centres  are  confidently  asserted 
to  be  localized  in  certain  parts  of  the  cortex,  just  mentioned, 
the  same  is  not  so  positively  stated  in  regard  to  centres  of 
sensibility. 

According  to  Betz,  of  Kiew,  the  postero-Iateral  regions  of  the 
gray  cortex  of  the  convolutions  are  destined  for  functions 
of  sensibility.  These  regions  would  comprise  the  convolu- 
tions in  which  the  ribbon  of  Yicq  d'Azyr  is  situated,  and 
particularly,  the  temporal  lobe  and  the  sphenoidal  lobe  in- 
cluding the  triangvlar  lobule  and  the  quadrilateral  lobule  placed 
upon  the  internal  face  of  the  hemisphere.  Some  authors 
locate  the  sensorium  commune^  the  common  centre  of  sensa- 
tion, in  these  regions,  and,  according  to  Charcot,  this 
hypothesis  is  founded  upon  anatomical  and  pathological 
considerations.  Admitting  the  fact  urged  by  many  ex- 
perimenters that  an  important  influence  resides  in  the  gray 
cortex  of  the  convolutions  in  certain  parts  of  the  brain  to 
which  certain  motor  and  sensory  functions  are  attributed, 
there  is  sufficient  proof  that  the  encephalon  is  the  seat  of 
the  various  phenomena  of  intelligence,  and  that  the  gray 
cortex  of  the  cerebral  convolutions,  regarded  as  a  whole,  is 
composed  of  a  plurality  of  nervous  centres  through  the 
functionating  powers  of  which  the  mental  faculties  are  per- 
formed and  made  manifest.  Moreover,  the  material  con- 
ditions of  the  intelligence,  of  the  sentiments  and  of  the 
instincts,  have  to  be  brought  into  correlation  and  asso- 
ciated with  each  other,  and  this  is  brought  about  by  the 
various  intercommunicating  medullary  white  fibres  of  which 
the  remaining  substance  of  the  convolutions  is  made  up. 

The  cortex  of  the  convolutions,  in  fact,  overlaps  and  en- 
doses  four  species  or  kinds  of  fibres  which  terminate,  most 


IN  RELATION  TO  INSANITY.  27 

probably,  among  the  cells  of  the  gray  substance  and,  from 
the  part  they  perform,  are  denominated  commissural  fibres  ; 
arcijorm  or  fibres  of  association  ;  peduncular  and  radiating 
fibres.  The  phenomena  of  the  special  senses  and  of  general 
sensibility  and  motion  are  entirely  mental  in  character  and 
are  the  productions  of  particular  cineritious  and  medullary 
centres.  It  is  only  carrj'ing  the  analogy  farther,  to  attribute 
the  intellectual,  affective  and  other  faculties  to  the  functional 
influence  evolved  from  the  ganglionic  centres  of  the  convolu- 
tions with  which  they  are  correlated.  Wherever  placed  in 
the  brain,  the  gray  matter  and  white  medullary  fibres  are  in 
direct  or  indirect  communication,  the  one  supplying  the 
ps^^chic  or  ideal  functionating  influence,  while  the  others  act 
as  the  internuncial  heralds  and  messengers. 

As  heretofore  mentioned,  Locke  compared  the  original 
vacant  condition  of  the  mind  to  a  white  sheet  of  paper,  (the 
tabula  rasa),  devoid  of  characters,  but  possessing  the  suscep- 
tibility of  receiving  and  retaining  perceptions,  from  impres- 
sions derived  through  the  external  senses,  which  percep- 
tions he  called  sensations.  This  class  of  perceptions,  accord- 
ing to  the  theory  of  Gall,  are  also  produced  through  the  ex- 
ternal senses  and  are  evolved  by  the  agency  of  peculiar 
stimuli  acting  upon  the  dormant  susceptibilities  of  the  cere- 
bral convolutions,  and  arousing  their  special  functions  into 
activity.  The  other  class  of  mental  action  or  ideas,  follow- 
ing sensation,  called  by  Locke  reflection,  and  which  he  sup- 
posed to  originate,  through  the  action  of  the  mind  itself, 
according  to  the  materialistic  doctrine,  would  be  considered 
as  nothing  more  than  the  active  ideation  of  the  cineritious 
cells  of  the  same  or  of  another  set  of  convolutions. 

The  phenomena  of  the  mind  are  apparently  so  infinite 


28  CEREBEAL    LOCALIZATION 

that  it  might  seem  a  hopeless  effort  to  attempt  to  reduce, 
under  a  few  heads,  the  innumerable  sensations  and  feelings 
which  diversify  almost  every  moment  of  existence.  The 
philosophers  of  various  sects,  however,  from  remote  ages, 
have  assumed  the  task  of  rendering  to  psychological  science 
the  same  kind  of  generalization  which,  in  physical  research, 
has  proved  of  such  utility,  by  adopting  systems  of  mental 
classification. 

One  leading  classification  which  was  sanctioned  and 
adopted  by  metaphysicians  for  many  ages,  is  the  division 
of  mental  phenomena  into  those  which  belong  to  the  under- 
standing, and  those  which  belong  to  the  loill. 

Another  division  of  the  phenomena  of  the  mind,  somewhat 
resembling  the  ancient  division  of  philosophy  into  the  con- 
templative and  the  active,  is,  into  those  which  belong  to  the 
intellectical  powers  and  those  which  belong  to  the  active 
powers.  Another  classification  of  mental  phenomena,,  more 
allied  to  the  views  entertained  by  the  metaphysicians  of 
the  different  systems  of  philosophy  of  the  present  day,  is  the 
arrangement  of  all  the  mental  phenomena  into  two  definite 
classes,  according  as  the  causes  or  immediate  antecedents  of 
our  feelings  are  themselves  material  or  mental.  The  former 
of  this  class — that  of  the  external  affections  of  the  mind — is 
so  simple  as  to  require  but  little  subdivision.  The  other 
class,  however,  that  of  the  internal  affections,  or  states  of 
mind,  comprehend  so  large  a  proportion  of  mental  phe- 
nomena, and  are  of  such  a  various  character,  as  to  require 
a  number  of  subdivisions. 

The  first  great  subdivision  of  the  internal  class  is  into  our 
intellectual  states  of  mind  and  our  emotions,  and  these  appear 
to   exhaust  completely  the  whole  internal  affections  of  th© 


IN  RELATION  TO  INSANITY.  29 

mind.  We  have  sensations  or  perceptions  of  the  objects  that 
affect  our  bodily  organs  ;  these  are  termed  sensitive  or  exter- 
nal affections  of  the  mind  ;  we  remember  objects,  we  imagine 
them  in  new  situations,  we  compare  their  relations,  these 
mere  conceptions  or  notions  of  objects  and  their  qualities,  as 
elements  of  our  general  knowledge  are  what  are  termed 
the  intellectual  states  of  the  mind ;  we  are  moved  with  cer- 
tain lively  feelings  on  the  consideration  of  what  we  thus 
perceive,  or  remember,  or  imagine,  or  compare,  with  feelings, 
for  example,  of  beauty,  or  sublimity,  or  astonishment,  or 
love,  or  hate,  or  hope,  or  fear  ;  these  and  various  other  vivid 
feelings,  analagous  to  them,  are  our  emotions. 

There  is  no  portion  of  our  consciousness  which  does  not 
appear  to  be  included  in  one  or  other  of  these  three 
divisions.  This,  in  brief,  is  the  classification  of  Brown,  and 
approaches,  by  purely  mental  ratiocination,  the  arrangement 
adopted  by  the  materialistic  philosophers. 

In  contrast  with  the  classifications  of  the  mental  phenom- 
ena just  mentioned,  formed  by  the  mind  itself  reasoning  upon 
the  mind,  is  the  classification  of  the  functions  of  the  mind 
constructed  upon  a  basis  purely  organic  or  material.  It  rests 
upon  the  doctrine  that  there  are  two  entities  only  in  nature 
— matter  and  mind ;  the  one  dependent  upon  the  other, 
both  indestructible,  but  susceptible  of  change  in  their 
relations.  The  brain  is  viewed  as  the  organ  of  the  mind, 
subdivided  into  a  plurality  of  organs,  which,  to  simplify 
description,  are  arranged  in  separate  regions  and  localized 
according  to  the  character  and  nature  of  their  special  func- 
tions. By  this  doctrine,  no  doubt  is  allowed  to  exist  in 
regard  to  the  functions  of  the  brain,  as  a  whole,  and, 
although  diversity  of  opinion  may  arise  as  to  the  precise 


30  CEREBRAL    LOCALIZATION 

assignment  of  place  among  the  co-operating  parts,  it  is 
asserted  that  in  the  encephalic  lobes  are  localized  the 
material  coiiditlons  of  intelligence,  the  sentiments,  and  the 
instincts.  The  classification,  thus  founded,  arranges  all  the 
mental  phenomena  into  the  intellect ual  faculties,  the  moral 
faculties,  and  the  affective  faculties,  including  the  animal  pro- 
pensities. 

In  order  to  render  more  intelligible  the  dogmas  of  the 
organic  classification,  a  new  nomenclature  for  certain  ex- 
pressions, such  as  faculty,  power,  activity,  memory,  atten- 
tion, perception,  and  conception,  has  been  adopted.  To  the 
process  of  the  mind,  as  manifested  through  the  action  of 
the  organs,  the  term  faculty  is  applied.  Power,  in  whatever 
degree  possessed,  is  capability  of  feeling,  perceiving,  or 
thinking.  Activity  is  simply  readiness  and  quickness. 
Memory  is  not  regarded  as  a  general /ac?^?/^/  of  the  mind, 
as  is  customary  with  the  metaphysicians,  but  is  considered 
an  attribute  or  a  mode  of  action  of  the  faculties.  Percep- 
tion is  a  susceptibility  of  an  organ  put  into  activity,  and  not 
a  distinct  faculty  of  mind,  so  of  conception,  it  is  but  a  mode 
of  action  of  the  faculties  and  not  a  faculty  ;  it  is  the  suscep- 
tibility of  the  faculties  started  into  activity  by  internal 
causes.  For  example,  in  regard  to  memory,  the  painter  may 
have  a  memory  for  colors  which  the  sculptor  does  not 
possess,  the  linguist  may  have  a  memory  for  language  not 
understood  by  the  mathematician,  and  so  on  with  other 
supposed  metaphysical  faculties  which  are  not  regarded  as 
such,  but  looked  upon  as  merely  susceptibilities  of  organs 
put  into  a  state  of  activity  by  external  or  internal  causes. 

On  the  external  aspect  of  the  Hemispheres,  the  three 
principal  fissures  are  seen,  the  fissure  of  Eolando,  the  fissure 


IN  RELATION  TO  INSANITY.  3l 

of  Sylvius  and  the  external  perpendicular  fissure.  Tlie  four 
lobes  of  the  hemispheres  are  divided  by  natural  fissures 
and  by  artificial  lines  ;  these  lobes  contain  the  convolutions 
which  are  limited  by  numerous  anfractuosities  coursing  in  a 
serpentine  manner  in  various  directions,  and  are  much  more 
regular  and  constant  than  might  be  expected  from  a  cursory 
examination.  The  same  general  disposition  of  furrows  and 
convolutions  is  found  to  be  present  upon  the  base  of 
the  brain  and  along  the  internal  surface  of  the  hemi- 
spheres. The  cerebral  lobes  are  named  according  to  their 
situation,  as  follows  :  the  Frontal  lobe,  the  Parietal  lobe,  the 
Temporo-sphenoidal  lobe  and  the  Occipital  lobe. 

The  Frontal  lobe  is  much  the  largest  of  the  four,  and  pre- 
sents, on  its  external  surface,  an  amount  of  cortical  or  gray 
substance  nearly  as  extensive  as  that  of  the  other  three  lobes 
united.  It  is  divided  from  the  parietal  lobe  by  the  fissure  of 
Eolando,  and  contains  within  its  limits  four  principal  con- 
volutions. The  frontal  ascending,  and  the  first,  second  and 
third  frontal  convolutions.  The  para-central  convolution  is 
partly  placed  upon  the  inner  aspect  of  the  lobe. 

The  Parietal  lobe  is  limited  in  front  by  the  fissure  of  Ro- 
lando, posteriorly,  although  imperfectly,  by  the  external  per- 
pendicular fissure,  inferiorly,  by  the  posterior  prolongation 
of  the  fissure  of  Sylvius.  Externally,  on  this  lobe,  a  notable 
fissure  is  met  with,  the  inter-parietal  fissare ;  and  three  con- 
volutions, the  ascending  parietal  convolution,  the  superior 
parietal  convolution  and  the  inferior  parietal  convolution. 
Upon  the  internal  hemispherical  aspect,  the  quadrilateral 
lobule,  the  precuneus  and  a  part  of  the  para-central  lobule 
are  placed. 

The  Temporo-sphenoidal  lobe  is  bounded  superiorly  by  the 


32  CEREBRAL  LOCALtZATiOl^ 

posterior  prolongation  of  the  fissure  of  Sylvius,  anteriorly  by 
the  anterior  part  of  the  fissure  of  Sylvius,  posteriorly,  by  an 
imaginary  perpendicular  line  dropped  from  the  posterior  part 
of  the  inter-parietal  fissure,  ending  at  the  basal  surface  of  the 
brain,  inferiorly,  by  the  surface  at  the  base  of  the  brain. 
This  lobe  contains  a  marked  fissure  called  the  parallel  fis- 
sure, and  the  temporal  convolutions  designated  as  the  first, 
second  and  third. 

The  Occipital  lobe  is  bounded  superiorly,  by  the  external 
perpendicular  fissure,  anteriorly,  by  the  imaginary  line  men- 
tioned as  forming  the  posterior  boundary  of  the  temporal 
lobe,  posteriorly,  by  the  cerebral  cortex,  and  inferiorly  by 
the  lower  part  of  the  hemisphere.  This  lobe  is  small,  irreg- 
ular, and  is  formed  by  three  convolutions,  the  superior  oc- 
cipital convolution,  the  middle  occipital  convolution,  and 
the  inferior  occipital  convolution.  The  internal  hemispher- 
ical aspect  presents  the  cuniform  lobule  and  the  fissure  of 
the  hippocampus.  This,  in  brief,  is  a  summary  of  the  lobes, 
convolutions,  fissures  and  lobules  of  the  cerebral  hemi- 
spheres. In  each  of  the  regions  thus  designated,  certain  or- 
gans are  localized,  and  when  subjected  to  certain  states  of 
activity,  the  various  mental  phenomena  of  which  the  mind  is 
susceptible  are  evolved. 

In  addition  to  this  analysis  of  the  action  of  the  mind,  it  is 
not  to  be  overlooked  that  there  exists  an  auxiliary  nervous 
apparatus  known  as  the  Organic  or  SympatJwtic  System  of 
nerves,  which  communicate  generally  with  the  other  part  of 
the  nervous  system  known  as  the  cerebro-spinal  axis.  The 
Sympathetic  system  of  nerves  supplies  the  organs  of  the  great 
splanchnic  cavities,  such  as  the  heart,  lungs,  stomach,  liver, 
etc.,  and,  anastomosing  freely  with  the  nervous  branches 


iii  RELATION  TO  INSANITY.  3^ 

springing  from  tlie  spinal  marrow  and  the  brain,  influences, 
in  health  and  in  disease,  the  functions  of  the  brain.  Morbid 
changes  that  occur  in  the  blood  and  the  Reflex  Action  of  some 
portions  of  the  nervous  system  must,  also,  be  recognized. 

The  improved  anatomy  of  the  brain  and  the  possibility  of 
assigning  to  particular  parts  of  the  cerebro-spinal  system 
certain   functions  with   invariable   exactness  have  recently 
directed  the   attention  of  physiologists  more   closely  to  the 
study  of  the  cerebral  cortex.     The  results  of  the  experiments 
of  Fritsch,  Hitzic  and  Terrier  are  prominent  in  reference  to 
the  localization  of   certain  motor  centres  among  the   sub- 
stance of  the  gray  matter  of  the  convolutions.     These  ex- 
periments seem  to  controvert  the  principle  so  long  main- 
tained that  the  gray  ganglionic  substance  of  the  brain  is  not 
excitable   by  the  electric  current,  or    any  other  stimulus. 
Although  the  doctrine  of  placing  motor  centres  in  the  con- 
volutions is  not  universally  accepted,  it  seems  as  likely  for 
motor  and  sensory  influence  to  be  located  in  the  substance 
of  the  gray  matter  of  the  cortex  as  among  the  gray  matter  of 
the  corpus  striatum,  a  fact  which  is  not  doubted  at  the  present 
time.     It  may  be,  that  extremely  delicate  medullary  fibres 
from  some   points  of  the  corona  radians  may  be  prolonged 
into  the  substance  of  the  cortex.     Be  this  as  it  may,  there  is 
undeniable  evidence  that  the  encephalon  presides  over  and 
functionates   the   phenomena    of  intellectual   and   affective 
ideation.     The  accumulation  of  facts  sufficiently  prove  this 
theory.     In  man,  the  moral  and  most  noble  qualities,  the 
ability  to  compare  impressions,  to  express  remembrance,  be- 
come enfeebled  or   entirely   disappear   when  grave   lesions 
of  the  encephalon  occur.     The  simple  compression  of  this 
organ  produces  a  state  of  torpor  or  of  coma  which   ceases 


34  CEREBRAL  LOCALIZATION 

with  the  removal  of  the  compression ;  the  development  of 
intelligence  and  of  the  moral  aptitudes  and  perceptions  fol- 
low, step  by  step,  the  evolution  of  infancy  and  the  perfec- 
tioning  of  the  encephalic  mass :  a  malformation  of  this  mass 
is  the  invariable  antecedent  cause  of  imbecility  or  idiocy. 
As  all  mental  phenomena  are  comprised  in  the  intellectual, 
the  affective  or  instinctive  faculties,  the  difficulty  of  assigning, 
in  the  present  state  of  science,  the  exact  confines  of  each  cere- 
bral organ,  does  not  controvert  or  invalidate  the  general  prin- 
ciple of  cerebral  localization,  or  disturb  the  proposition  that 
there  is  always  present  a  mutual  and  reciprocal  relation  be- 
tween the  existence  of  material  organs  with  the  performance 
of  mental  functions.  It  is  well  known  and  established  that 
the  functions  of  sensation  and  motion  are  definitely  placed 
in  certain  fixed  localities  of  the  medulla  spinalis  and  brain, 
that  the  vital  actions  necessary  for  the  completion  of  respira- 
tion, of  circulation,  of  digestion  and  other  important  functions 
have  their  functional  origin  in  and  about  the  medulla  ob- 
longata— that  the  origin  of  the  nerves  of  special  sense  have 
their  definite  site  in  the  part  of  the  brain  assigned  to  them, 
that  the  pons  varolii,  the  tubercula  quadrigemina,  the  optic 
thalami,  and  the  corpora  striata  have  their  individual  func- 
tions allotted  to  them,  and  that  among  the  convolutions  of 
the  brain  the  function  of  the  ideation  and  the  exercise  of  arti- 
culate language  is  distinctly  placed  in  the  third  frontal  con- 
volution of  the  left  hemisphere.  The  principal  once  estab- 
lished, that  the  brain  is  a  multiple  organ  composed  of  many 
organs  and  that  the  site  of  an  organ  and  its  function  can  be 
localized  and  separated  from  the  others  in  the  general  struc- 
ture of  the  encephalon,  is  sufficient  to  authorize  the  asser- 
tion, by  induction,  that  each  mental  function  must,  also,  be 


IN  RELATION  TO   INSANITY.  35 

associated  with  its  especial  organ.  Upon  this  correlation  of 
organ  and  function,  a  system  of  mental  philosophy  may  be 
formed,  resting  upon  a  more  solid  basis  and  of  more  easy 
comprehension  than  the  systems  of  metapliysics  founded  by 
reasoning  emanating  from  the  action  of  the  mind  itself,  re- 
flecting upon  itself,  in  order  to  arrive  at  conclusions.  This 
view  of  the  constitution  of  the  mind  will  lead  to  a  more  cor- 
rect understanding  of  the  subject  of  insanity. 

The  healthy  condition  of  the  organs  and  the  harmony  of 
action  existing  between  organ  and  function  will  indicate  a 
healthy  condition  of  mind — the  mens  sana.  The  disturbance 
of  this  harmony  of  action,  occurring  from  a  morbid  condition 
of  the  organs,  will  result  in  disease  and  disturbance  of  the 
mental  functions,  whence  insanity  arises — the  non  compos 
mentis  of  jurists. 

It  is  not  necessary,  at  present,  to  claim  for  the  doctrine  of 
localization  the  precise  limitation  of  the  cerebral  organs. 
What  is  claimed  for  the  principle  is,  that  the  brain,  as  a 
whole,  is  the  organ  of  the  phenomena  of  mind,  that  it  is 
composed  of  an  aggregation  of  organs,  and  that  the  organs 
are  the  functionating  sources  of  the  individual  mental  func- 
tions. It  remains  for  the  future  to  develop  the  system,  as 
has  been  done  iu  other  organs,  by  physiological  and  patho- 
logical research,  as,  for  example,  the  localization  of  the 
organ  and  function  of  articulate  language  in  the  convolution 
of  Broca. 

From  observation  and  from  comparative  and  pathological 
anatomy,  certain  mental  faculties,  under  different  terms,  have 
been  allotted  to  certain  regions  of  the  encephalon.  To  the 
frontal  lobes  have  been  assigned  the  organs  of  the  intellect- 
ual faculties ;  to  the  posterior  or  occipital  region,  the  affect- 


36  CEREBRAL    LOCALIZATION 

ive  or  emotional  organs ;  to  the  temporo-spJienoidal  regions, 
the  animal  propensities,  while  the  moral  sentiments  are 
stated  to  have  their  organs  developed  on  the  coronal  region 
of  the  brain.  These  assignments  of  place,  whether  alto- 
gether correct  or  otherwise,  will  serve  as  a  basis  for  the 
farther  confirmation  of  the  doctrine  of  cerebral  localization. 

As  regards  the  proposed  definition  of  Insanity,  it  is  neces- 
sary to  admit  the  doctrine  as  established,  that  the  Brain  is 
the  organ  of  the  mind ;  that  it  is  a  complex  machine 
composed  of  many  parts  through  the  instrumentality 
or  functionating  influence,  of  which  all  mental  phenom- 
ena are  manifested.  With  this  view  of  the  functions  of  the 
brain  and  of  the  localization  of  the  organs,  it  must  also  be 
understood,  that  though  all  the  organs  of  the  brain  may  be 
diseased  at  once,  yet  that  it  is  quite  possible  for  some  organs 
to  be  in  a  diseased  or  abnormal  condition,  while  others,  at 
the  same  time,  are  perfectly  healthy.  The  influence  of  the 
Organic  system  of  nerves  distributed  to  the  organs  of  the 
great  splanchnic  cavities,  and  the  sympathies  exercised 
through  them  upon  the  Encephalon,  have  to  be  considered, 
in  studying  the  direct  and  indirect  etiological  sources  of  In- 
sanity. 

As  Ideation  or  the  operations  of  the  Brain  are  accom- 
plished at  the  expense  of  changes — of  partial  or  total  disin- 
tegration taking  place  in  the  cells  of  the  gray  matter — it  can 
be  understood  that  particular  organs  may  suffer  if  their 
functions  are  overtaxed  beyond  the  physiological  limit  of 
waste  and  repair.  If  this  pre-established  harmony  of  relative 
metamorphosis,  continually  progressing  in  health,  become 
temporarily  disturbed,  modifications  of  cerebral  change  must 
■occur,  accompaaied  by  signs  of  mental  exhaustion  or  dis- 


IN  RELATION  TO  INSANITY.  37 

turbance ;  if  prolonged  for  a  length  of  time  abnormal  men- 
tal manifestations  will  appear,  representing  different  forms 
of  insanity,  according  to  the  degree  or  intensity  of  the  pro- 
gressive change  and  the  character  and  number  of  the  impli- 
cated organs. 

From  the  premises  just  given,  a  correct  definition  of  In- 
sanity would  be,  a  morbid  condition  of  a  part  or  of  the  whole 
brain,  as  manifested  by  correct  reasoning  from  false  prem- 
ises ;  by  incorrect  reasoning  from  correct  premises ;  and  by 
incorrect  reasoning  from  false  premises,  according  to  the  kind 
of  insanity. 

In  the  first  case,  the  false  premises  originate  in  one  part 
of  the  brain  which  is  diseased  while  the  other  part,  the 
reasoning  part,  is  sound  and  acting  correctly.  In  the  second 
case,  the  premises  originate  in  a  healthy  part  of  the  brain, 
while  the  reasoning  organs  are  morbidly  affected.  In  the 
third  case,  the  part  of  the  brain  in  which  the  premises 
originate  and  also  the  reasoning  part,  are  both  morbidly 
affected  or  diseased. 

This  definition  is  not  hypothetical :  it  is  founded  upon  the 
character  and  constitution  of  the  normal  mind  and  from 
observation  and  study  of  the  Insane,  while  living,  followed 
up  by  future  necroscopic  examination.  Resting  upon 
Organized  Structure  for  its  derivation,  it  will  lead  to  more 
correct  methods  of  reasoning  when  mental  Alienation,  in 
its  diversified  modifications  and  phases,  becomes  the  subject 
of  discussion  or  of  judicial  investigation. 

The  arguments  and  statements  here  advanced  concern- 
ing evolution,  and  the  dependence  of  mind  upon  matter,  to 
prove  and  establish  a  scientific  proposition,  are  in  no  way  cor- 
roborative of  Peism  or  Atheism.     The  Creator  chooses  His 


38  CEREBRAL  LOCALIZATION 

own  way  of  maiutaining  correlation  between  man  and  Him- 
self, and  has  planted  in  the  human  brain  a  set  of  organs 
which  obliges  us  to  acknowledge  the  great  First  Cause  "  who 
hath  produced  and  will  receive  the  soul." 


The  following  cases  of  cerebral  disease  typically  illustrate 
the  perversion  of  function  in  co-relation  with  the  locality  of 
the  lesion.  In  three  of  the  cases  given  in  detail,  a  limited 
portion  of  the  brain  was  changed  in  structure,  while  the  cor- 
tex of  the  convolutions  remained  sound  and  functionated  in 
a  normal  manner  ;  the  fourth  case  is  an  example  of  the  mor- 
bid condition  of  the  encephalon,  mainly  of  the  cortex,  fol- 
lowed by  acute  mania  in  which  all  the  psychical  functions 
were  abnormally  manifested  : 

Case  1. — The  history  of  which  dates  back,  during  its 
progress  as  far  as  twenty  years,  commenced  with  cerebral 
sanguineous  effusion  accompanied  by  an  apoplectic  seizure, 
and  terminated  by  abdominal  dropsy  and  cirrhosis  of  the 
liver.  The  autopsy  confirmed  in  a  very  positive  manner  the 
connection  that  existed  between  the  cerebral  lesions  and  the 
symptoms  following  the  several  attacks,  taking  place  at 
short  intervals,  at  the  beginning  of  the  disease.  The  injury 
found  to  have  been  inflicted  upon  the  deep-seated  portions 
of  the  cerebrum  in  proximity  to  and  in  the  structure  of 
the  basal  ganglions  indicated  severe  shock  at  the  time  of 
seizure. 

The  patient,  A F ,  merchant,  set.  50,  orig- 
inally of  good  constitution,  of  superior  intelligence,  san- 
guineo-nervous  temperament,  and  of  exceedingly  sensitive 


m  RELATION  TO  INSANITY.  39 

disposition,  after  a  prolonged  period  of  bad  health,  the 
principal  feature  of  which  was  a  hemiplegic  condition  of  the 
right  side,  called  me  in  consultation  for  the  first  time,  about 
two  years  previous  to  his  decease.  The  history  of  the  case 
up  to  that  time  was  related  to  me  by  a  member  of  his  fam- 
ily, as  follows  :  On  August  1,  1862,  at  the  age  of  thirty  two, 
while  laboring  under  great  mental  depression  and  agitation, 
and  under  the  strain  of  anticipated  commercial  disaster,  he 
was  suddenly  seized  about  mid-day  with  an  apoplectic  at- 
tack, and  was  discovered  in  his  library  lying  prostrate  upon 
a  sofa,  completely  insensible,  breathing  stertorously,  and 
showing  the  other  signs  of  cerebral  sanguineous  eifusion.  A 
physician  was  hurriedly  called.  The  patient  was  carried  up 
one  flight  of  stairs  to  bed,  and  received  proper  medical  at- 
tention. In  twenty-four  hours  he  showed  signs  of  improve- 
ment, and  by  the  following  Sunday  had  so  far  recuperated 
as  to  sit  up  in  bed  and  read  the  morning  papers.  During 
the  night  (about  2  A.  m.)  he  was  again  taken  very  ill,  losing 
his  speech  and  the  power  of  locomotion.  In  about  a  week 
after  this  attack  he  regained  in  a  great  degree  his  speech, 
and  began  slowly  to  recover  somewhat  the  power  of  walking. 
In  September,  under  advice,  he  went  to  the  country,  and 
continued  to  improve,  gaining  strength.  This  favorable  turn 
in  his  condition  was  but  of  short  duration  ;  for  in  February, 
some  five  months  alter  the  second  attack,  he  experienced 
another  severe  paralytic  stroke,  falling  suddenly,  while  at 
the  breakfast  table,  to  the  floor,  insensible,  speechless,  and 
unable  to  move,  with  other  symptoms  so  grave  that  his  fam- 
ily supposed  he  was  dying.  He  continued  without  much 
change  in  this  helpless  condition  for  about  two  weeks.  He 
then  commenced  to  show  signs  of  returning  intelligence,  and 


40  CEREBRAL  LOCALIZATIOl^ 

after  a  time  regained  very  slight  locomotive  power.  His 
right  side  remained  paralytic,  the  right  arm  useless,  and  in 
efforts  to  walk,  the  right  leg  was  put  in  motion  mainly  by 
being  dragged.  He  was  never  able  to  assist  in  dressing  him- 
self after  the  last  attack,  and  alluded  to  the  paralytic  side  as 
his  "dead  side."     Speech  remained  thick  and  indistinct. 

The  above  statement  contains  the  main  features  of  this 
patient's  history  from  the  inception  of  his  malady  up  to  the 
time — a  period  of  about  eighteen  years — when  I  was  iSrst 
called  to  see  him.  Notwithstanding  the  prolonged  duration 
of  the  hemiplegia,  the  anterior  part  of  the  brain,  after  the 
immediate  rude  effects  of  the  effusion  had  subsided,  con- 
tinued to  act  normally,  and  although  otherwise  helpless  in  a 
great  degree,  he  directed  his  private  affairs  and  household 
arrangements  with  discretion  and  good  judgment. 

The  muscles  of  the  face  supplied  by  the  portio  dura,  and 
of  the  orbit  by  the  third  pair  or  motores  oculorum,  showed  no 
signs  of  morbid  action.  The  organs  of  special  sense  mani- 
fested no  impairment  of  function  until  the  last  year  of  his 
illness,  when  vision  became  defective,  indicating  extension  of 
the  cerebral  lesion,  and  articulation  was  so  difficult  as  to 
render  speech  barely  intelligible.  At  this  period  the  left  side 
became  affected  by  loss  of  sensation. 

After  the  acute  symptoms  of  the  attack  alluded  to  had 
subsided  the  patient  fell  into  a  passive  state,  hemiplegia  of 
the  right  side  being  confirmed,  and  medical  treatment  of 
little  use.  He  was  well  nursed,  received  every  hygienic  at- 
tention, and  his  general  health  was  good.  He  was  in  the 
habit  of  spending  the  summers  at  his  country-seat  to  avoid 
the  heat  of  the  city,  returning  to  town  at  the  beginning  of 
winter    In  the  autumn  of  1880  he  became  worse,  and  I  was 


In  relation  to  insanity.  41 

then  requested  to  visit  liira.  At  this  time,  the  hemiplegia 
was  very  complete,  the  right  leg  dragging  helplessly  in  any 
attempt  at  locomotion,  and  the  right  arm  hanging  lifelessly 
by  the  side,  with  some  contraction  of  the  wrist  and  fingers. 
Sensation,  also,  on  this  side  was  much  impaired.  Under  the 
influence  of  tonics — quinine,  nux  vomica,  phosphorus,  etc. — 
administered  in  small  doses,  slight  improvement  took  place. 
He  continued  to  be  interested  in  daily  affairs,  read  the  news- 
papers, and  supervised  some  building  operations.  About 
twelve  months  prior  to  his  death  general  sensibility  on  both 
sides  became  still  more  diminished,  and  on  the  left  side  to 
the  extent  of  losing  almost  entirely  the  sensation  of  touch. 
Vision,  also,  became  so  impaired  as  to  prevent  his  reading 
the  daily  papers,  which,  being  one  of  the  few  pastimes  still 
left  to  him,  caused  him  to  become  greatly  disheartened  and 
despondent.  A  slight  improvement  afterward  took  place  in 
the  eyesight,  and  also  in  the  tactile  perceptions  of  the  left 
side,  but  neither  was  restored  to  its  condition  prior  to  the 
relapse.  In  the  early  part  of  1882  a  sharp  attack  of  jaun- 
dice came  on,  with  tenderness  over  the  hepatic  region.  This 
was  followed  by  induration  of  the  liver,  oedema  of  the  limbs, 
and  abdominal  dropsy,  which  required  the  operation  of 
paracentesis  to  relieve  the  distress  resulting  from  distension 
and  difficulty  of  respiration.  The  patient  continued  to  grow 
weaker,  and  gradually  sank  under  the  various  complications 
from  which  he  had  suffered,  dying  in  August  of  the  same 
year,  about  twenty  years  after  the  first  paralytic  stroke. 

The  immediate  cause  of  death  in  this  case  was  cirrhosis 
of  the  liver  and  its  sequent  abdominal  dropsy.  The  diag- 
nosis I  had  given  during  life  attributed  the  primary  disease 
— the  apoplectic  seizures,  accompanied  by  hemiplegia,  and 


42  CEREBRAL  LOCALIZATION 

subsequently  complicated  with  partial  anaesthesia — to  san- 
guineous effusion  in  the  region  of  the  corpus  striatum  of  the 
left  side,  followed  by  softening  of  the  structureof  the  corpus 
striatum,  this  invading  the  internal  capsule,  and  extending  to 
parts  of  the  optic  thalamus  of  the  same.  side. 

TJie  loss  of  sensation  and  the  diminution  of  motor  power 
on  the  left  side  and  the  defect  of  vision  can  be  accounted  for 
by  the  diseased  ^jondition  of  the  lenticular  portion  of  the 
corpus  striatum,  of  part  of  the  optic  thalamus  of  the  rigJit 
side,  and  of  the  posterior  portion  of  the  internal  capsule, 
occurring  during  the  progress  of  the  malady,  and  which  the 
autopsy  revealed. 

AuTOPBY.-:-The  brain  was  placed  on  a  marble  slab,  the 
base  downward.  With  a  fine  cerebrum  knife  the  left  hemis- 
phei*e  was  cut  horizontal!}^  so  as  to  expose  the  centrum  ovale 
of  Vieussens  ;  another  section,  about  four  millimetres  deeper 
on  the  hemisphere,  was  then  made  in  the  same  direction, 
immediately  over  the  roof  of  the  lateral  ventricle*  The 
lateral  ventricle  was  now  laid  open  by  inserting  the  handle 
of  a  scalpel  along  the  internal  margin  and  breaking  down 
the  roof  of  the  ventricle  as  far  as  the  interior  and  poste- 
rior cornua,  and  pushing  externally  to  one  side  the  white 
substance  overlying  the  ventricle.  The  upper  surface  of 
the  corpus  striatum,  the  optic  thalamus,  the  choroid  plexus, 
velum  interpositum,  and  other  parts  of  the  ventricle  were 
thus  exposed.  The  two  last-mentioned  structures  being  re- 
moved, the  upper  surfaces  of  the  corpus  striatum  and  of  the 
optic  thalamus  were  fully  brought  into  view,  and  presented 
the  smooth,  normal  appearance  common  to  the  lining  mem- 
brane of  the  ventricle.  A  section  was  next  made  by  passing 
the  knife  vertically  and  transversely  across  the  frontal  lobe 


IN   RELATION  TO   INSANITY.  43 

immediately  in  front  of  the  anterior  extremity  of  the  corpus 
striatum.     This  section  was  joined  by  another  carried  longi- 
tudinally and  vertically  backward  near  and  parallel  to  the 
great  median'  fissure,  thus  detaching  a  somewhat  triangular 
portion  of    the  frontal  lobe,  and   exposing  the  structure  of 
the  anterior  extremity  of  the  corpus  striatum  and  of  the^  in- 
dentations in  front  of  the  convolutions  of  {he  island  of  Keil. 
On  the  surface  thus  presented  nothing  abnormal  was  seen. 
Another  transverse   section,  parallel  to  the  previous  one, 
and  about  five  millimetres  posterior  to  it,  was  made  through 
the    corpus   striatum    and    the   other   tissues   immediately 
below  it.     The  face  of  this  section  showed  the  fibres  of  the 
internal  capsule  located  between  the  gray  substance  of  the 
caudate  and  lenticular  ganglions  to  be  in  a  diseased  condi- 
tion.    The  lenticular  portion  presented  a   small  cavity  sur- 
rounded by   yellow,    softened    structure  encroaching  upon 
the  medullary  fibres  of  the  internal   capsule.     A  third  sec- 
tion  was  now   made,  about  three   millimetres  behind  the 
second,  parallel  to  it,  and  a  little  in  front  of  the  line  of  de- 
pression that  exists  between  the  corpus  striatum  and  the 
optic  thalamus.     This  section  opened  up  the  middle  part  of 
the  corpus  striatum,  in  which  was  found  a  cavity,  when  held 
apart,  large  enough  to  contain  a  small  bean,  and  the  walls  of 
which,  to  the  extent  of  several  millimetres,  were  surrounded 
by  a  pultaceous  creamy  substance  which  here  invaded  and 
destroyed  the  fibres  of  the  internal  capsule.     The  internal 
surface  of  this  cavity  was  in  part  rough,   congested,  and  of 
dark  purple  color.      It  extended  a  short  distance  into  the 
anterior  and  external  side  of  the  optic  thalamus,  and  was 
there  also  surrounded  for  a   space  of  some  millimetres  by 
softened  cerebral  substance.    A  fourth  transverse  and  verti- 


44  CEREBRAL  LOCALIZATION 

cal  section  was  made,  through  the  anterior  third  of  the  optic 
thalamus.  This  showed  the  termination  of  the  cavity 
and  softened  substance  mentioned  as  existing  in  the 
corpus  striatum  and  extending  into  the  antero-lateral  part 
of  the  optic  thalamus.  A  fifth  transverse  and  vertical  sec- 
tion continued  the  examination  across  and  through  the 
posterior  third  of  the  optic  thalamus,  exposing  a  cavity 
large  enough  to  contain  a  garden  pea.  This  centre  of 
hemorrhagic  effusion  was  found  also  surrounded  by  softened 
structure.  A  transverse  and  a  vertical  section  made  on  a 
level  with  the  margin  of  the  anterior  tubercles  (the  nates)  of 
the  tubercula  quadrigemina  showed  nothing  abnormal.  A 
transverse  section  made  to  drop  vertically,  as  if  through  the 
^arieto-occipital  lobes,  exposed  a  cavity  in  the  white  cere- 
bral substance,  nearly  on  a  level  with  the  centrum  ovale, 
large  enough  to  contain  an  ordinary-sized  filbert.  The  wall 
of  this  cavity  was  directed  toward  the  cuneiform  lobe,  and 
extended  superiorly  in  the  direction  of  the  convolutions  of 
the  quadrilateral  lobe.  The  white  structure  around  this 
cavity  was  soft  and  pultaceous  to  the  extent  of  several  milli- 
metres. The  remaining  parts  of  the  left  cerebral  hemis- 
phere presented  no  deviations  from  the  normal  condition. 

The  i^ight  cerebral  hemisphere  was  now  examined  by  first 
making  the  ordinary  transverse  section  of  the  hemisphere  to 
expose  the  white  substance  of  the  centrum  ovale  of  Yieus- 
sens.  A  similar  section,  carried  some  lines  deeper,  opened 
a  cavity,  situated  about  the  centre  of  the  white  substance  of 
the  cerebrum,  of  sufficient  extent  to  contain  a  large-sized 
hazel-nut.  This  cavity  was  somewhat  triangular  in  shape, 
extended  laterally  and  internally  toward  the  outer  side  of  the 
optic  thalamus  and  of  the  corpus  striatum,  and  externally 


IN  RELATION   TO   INSANITY.  45 

about  three  centimetres  and  a  half  from  the  ascending  pari- 
etal lobe.  The  perimeter  of  the  cavity  was  surrounded  by 
softened  cerebral  structure,  invading  inwardly  the  external 
wall  of  the  lateral  ventricle,  the  lenticular  portion  of  the 
corpus  striatum  external  to  the  internal  capsule,  and,  to  a  limi- 
ted extent,  the  posterior  part  of  the  internal  capsule.  The 
caudate  ganglion  and  the  anterior  portions  of  the  internal 
capsule  were  found  to  be  unchanged.  The  remaining  parts 
of  the  white  medullary  substance  of  the  right  and  left  hem- 
ispheres presented  nothing  abnormal.  The  gray  cortical 
substance  overlying  the  lobes  and  lobules  of  both  hemis- 
pheres was  in  a  perfectly  healthy  condition,  as  were  also  the 
dura  mater,  pia  mater,  and  arachnoid  membranes.  The  an- 
fractuosities  or  sulci  between  the  convolutions  were  of  un- 
usual depth,  particularly  in  the  fronto-parietal  regions. 

Upon  a  careful  examination  of  the  external  and  internal 
structure  of  the  cerebellum,  no  change  from  the  normal  or- 
ganization was  perceptible. 

The  localization  of  the  cerebral  structures  at  fault  in  this 
case  was  diagnosticated,  during  life.  The  loss  of  motion  on 
the  left  side  was  characteristic  of  disease  of  the  corpus 
striatum,  including  part  of  the  internal  capsule  of  the  left 
hemisphere.  The  anaesthesia,  diminished  motor  power  on 
the  left  side  and  imperfection  of  vision  appearing,  during 
the  progress  of  the  disease,  represented  the  extension  of  the 
cerebral  softening  {ramollissement)  of  the  external  part  of  the 
corpus  striatum  of  the  right  hemisphere  and  of  the  optic 
thalami.  The  cavity  and  softening  found  around  it  in  the 
posterior  part  of  the  left  hemisphere  in  proximity  to  the 
gyrus  angularis  may  have  modified  somewhat  the  function  of 
vision, 


46  .  CEREBEAL  LOCALIZATION 

The  defective  articulation  resulted  from  the  Wallericm 
degeneration,  met  with  in  the  medullary  strands,  passing 
backward  and  downward  from  the  basal  ganglions  through 
the  medulla  oblongata,  interfering  with  the  origin  and  func- 
tion of  the  hypoglossal  nerve. 

Case  2. — Is  noticeable  from  the  definite  localization  of  the 
disorganization  of  cerebral  structure  and  the  equally  limited 
perversion  of  function,  Experiments  by  vivisection,  and 
more  particularly  pathological  observations,  attest  the  inti- 
mate connection  of  the  tuber cula  qiiadrigemina  with  the  rest 
of  the  nervous  apparatus  of  vision. — A  male  patient,  aged 
thirty-five  years,  of  spare  habit  and  in  feeble  health,  was  ad- 
mitted to  'the  ophthalmic  department  of  the  State  Immi- 
grants' Hospital,  for  amaurosis.  He  was  entirely  blind  in 
both  eyes,  not  being  able  to  distinguish  light  from  darkness 
in  open  day.  His  face  presented  a  vacant  stare,  the  pupils 
dilated  and  irresponsive  to  light,  and  the  globes  of  the  eyes 
apparently  immovable.  He  walked  with  the  unsteady  gait 
of  the  blind,  and  had  somewhat  lost  the  power  of  locomo- 
tion. The  internal  humors  of  the  eyes  were  translucent ; 
the  retinae  appeared  pale,  anaemic,  and  somewhat  puckered. 

This  patient  contracted  a  typhoid  fever,  to  which  he  suc- 
cumbed three  weeks  after  the  attack,  and  thus  afforded  an 
opportunity  for  a  postmortem  examination.  The  brain,  with 
the  exception  of  being  somewhat  paler  than  natural,  pre- 
sented nothing  specially  abnormal  until  reaching  the  region 
of  the  tubercula  quadrigemina.  A  bundle  of  hydatids,  two 
of  them  as  large  as  good-sized  peas,  with  several  others  of 
smaller  proportions,  was  to  be  seen  directly  over  and  im- 
planted upon  these  organs.  The  tubercula  quadrigemina 
were  slightly  atrophied,  and  the  process  of  ramolUssement  had 


IN  RELATION    TO  INSANITY.  47 

begun.  The  optic  tracts,  chiasma,  and  optic  nerves  were 
abnormally  wliite,  shrunken,  and  cord-like,  and  the  retinae 
paler  than  natural,  and  somewhat  atrophied.  The  diagnosis 
had  decided  the  amaurosis  to  have  originated  from  cerebral 
disturbance,  and  suitable  treatment  had  been  observed, 
without  any  beneficial  result. 

Case  3. — Another  case  of  similar  import  to  that  just  re- 
lated is  recorded  by  Jobert  de  Lamballe. 

"Chez  un  malade, la  vue  baissa  graduellement, les  pupilles 
se  dilaterent,  et  il  n'y  eut  plus  perception  que  d'une  faible 
lueur.  C'est  par  I'oeil  droit  que  la  perte  de  la  vue  commen^a, 
et  bientot  I'oeil  gauche  cessa  de  voir  a  son  tour.  L'autopsie 
fit  decouvrir  une  tumeur  comprimant  les  tubercules  quad- 
rijumeaux  :  mais  la  'paire  gauche  avait  plus  souffert  de  la 
compression  que  la  droite  ;  aussi  I'atrophie  etait-elle  plus 
marquee  chez  la  premiere." 

The  previous  cases,  in  which  the  internal  cerebral  structure 
was  found  to  be  deceased,  manifesting  corresponding  special 
functional  disorder,  while  the  cortex  of  the  convolutions  con- 
tinued to  perform  its  functions  normally,  are  in  contrast 
with  the  following  case  in  which  the  cortex  was  found  at 
fault,  accompanied  by  symptons  of  acute  mania,  while  the 
functions  of  motion  and  of  general  and  special  sensation 
were  not  lost. 

Case  4. — I  was  lately  called  in  consultation  to  see  a  gentle- 
man, about  forty  years  of  age,  originally  of  good  constitution, 
a  free  liver,  addicted,  at  times,  to  immoderate  use  of  alco- 
holic liquors.  At  my  visit,  he  was  laboring  under  the  symp- 
toms of  acute  mania — flushed  face,  wild  and  vacant  expres- 
sion, restlessness,  throwing  himself  upon  a  couch  and  getting 
suddenly  up,  walking  rapidly  to  and  fro,  incoherent,  full  of 


48  CEREBRAL  LOCALIZATION  IN  RELATION  TO   INSANITY. 

delusions  and  hallucinations,  imagining  the  presence  of  hid- 
eous animals  and  of  non-existing  dangers  to  his  person,  mut- 
tering unintelligible  sentences  and  utterly  uncognizant  of  his 
condition  and  of  the  entreaties  of  his  attendants.  The  pulse 
was  rapid,  great  thirst,  refusing  food,  at  times  inclined  to  be 
violent. 

These  symptoms  continued  unabated  for  a  period  of  two 
days,  when  the  patient,  gradually  becoming  weaker,  finally 
ran  into  a  comatose  condition  and  died,  laboring  under  the 
symptoms  of  cerebral  effusion. 

Autopsy. — Upon  removal  of  the  calvarium  and  opening 
the  dura  mater^  a  quantity  of  serous  fluid  escaped,  exposing 
the  upper  surface  of  the  encephalon.  Both  hemispheres 
presented  a  congested  state,  the  veins  running,  tortuous 
over  the  convolutions,  distended  with  dark  colored  blood. 
The  arachnoid  exhibited  generally  a  thickened,  opaline  ap- 
pearance. The  pia  mater  was  universally  red,  showing  a 
vascular  condition,  as  if  injected  by  colored  "  size."  This 
appearance  was  also  manifested  in  the  anfractuosities  be- 
tween the  convolutions.  The  ventricles  were  full  of  yellow 
serum,  and  the  vellum  interpositum  and  choriod  plexuses 
were  turgid  with  blood. 

A  section  of  each  hemisphere,  exposing  the  white  sub- 
stance of  the  centrum  ovale  displayed  an  unusual  number 
red  dots  of  escaping  blood,  showing  that  the  medullary  sub- 
stance of  the  brain  had  participated  somewhat  in  the  severi- 
ty of  the  attack,  but  no  other  morbid  changes  were  found  in 
the  internal  substance  of  the  brain. 

In  this  case,  the  characteristic  pathological  changes  of  the 
encephalon  were  followed  by  manifestations  of  universal  and 
overwhelming  mental  aberration,  in  the  form  of  acute  mania. 


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